NCGNE0510_COMPLETE FILE - HISTORICAL_20090313

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V U&I Y t=USI D
DOC TYPE VHISTORICAL FILE
0 MONITORING REPORTS
DOC DATE ❑ �W S D� I3
YYYYMMDD

;AIF
DEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 27, 2009
RECEIVED i
N.C.Deot of ENR t
Mr. Harry Juncker
Hubbell ICD MAR 33 20M
4301 Cheyenne Drive winston•salem
Archdale, NC 27263 Regional off ce
Subject: No-Exposure Certification NCGNE0510
Hubbell ICD
4301 Cheyenne Dr., Archdale, NC 27263
Randolph County
Dear Mr. Juncker:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting as provided for under 40 CFR 126.22(g), which is
incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-exposure
conditions at your facility. If conditions change such that your facility can no longer qualify for a no-exposure
exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater discharge.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your conditional no-
exposure exclusion expires in five years (February 26, 2014). At that time you must re-certify with the Division, or
obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Robert Patterson at [phone], or at
[e-mail].
Sincerely,
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Mike Mickey
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 NorthCarolina
Location:5129-8 7 Salisbury 5t.Raleigh,North Carolina 27604
r Sery �ahara rly
Phone:919�807.6300 4 FAX:919$07-64941 Customer Service:1-877-623-6748 l
Internet!www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

Comments for NGNE0510
Subject: Comments for NGNE0510
From: Mike Mickey <Mike.Mickey ci ncrnail.net>
Date: Tue, 09 Dec 2008 13:00:56 -0500
To: Sarah Youn-, <[e-mail]>
Sarah - Hubbell ICD meets the conditions to qualify for the No Exposure Certification. Please issue.
Thanks, Mike.
Mike Mickey
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Main Office: (336) 771-5000
Voice: (336) 771-4962
FAX: (336) 771-4630
e
1 of 1 1/3 1/2009 3:01 1'M

-F
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 27, 2009
Mr. Harry Juncker
Hubbell ICD
4301 Cheyenne Drive
Archdale, NC 27263
Subject: No-Exposure Certification NCGNE0510
Hubbell ICD
4301 Cheyenne Dr., Archdale, NC 27263
Randolph County
Dear Mr. Juncker:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting as provided for under 40 CFR 12622(g), which is
incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-exposure
conditions at your facility. If conditions change such that your facility can no longer qualify for a no-exposure
exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater discharge.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your conditional no-
exposure exclusion expires in five years (February 26, 2014). At that time you must re-certify with the Division, or
obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or.need further information, please contact Robert Patterson at(919) 807-6375, or at
[e-mail].
Sincerely,
OR014AL SIGNED By
KEN PICKLE
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Mike Mickey
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One
1617 Mail service Center,Raleigh,North Carolina 27699-1617 North Carol i n a
Location: 9-8 7 Salisbury : Raleigh,North Carolina r 7604
Service:
�atu Nully
Phone:919$07-631]I]1 FAX:919-$D7-64941 Customer Service:1�77�i23-6748
Internet:www,ncwaterquality.org
An Equal opportunity 1 Afrirmabve Action Employer

FOR AGENCY USE ONLY
Date Received
Division of Water Quality /Surface Water Protection Year I Month nay
Aj 0 .. m Uj I U7 I Z:::Z
���E�R National Pollutant Discharge Elimination System CertiricataofCaverage
Nff+*.C.PilUM�.Qv Arr.EM OF NO EXPOSURE CERTIFICATION for Exclusion C N E c a
y./If1IXIM�lIi AN9 NAlnFL RG9IXh1C6
NCGNE0000
NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusion from a atef Penny u
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility doesW"o('requir" a �K
authorization for its stormwater discharges associated with industrial activity in the State -Nor#W o
Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at ai dial '
facility means all industrial materials and activities are protected by a storm resistant shelte ome
exceptions) to prevent exposure to rain, snow, snowme14 and/or runoff.
Industrial materials or activities include,but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste
products. Material handling activities include the storage, loading and unloading, transportation, or
conveyance of any raw material, intermediate product, final product or waste product A storm resistant
shelter is not required for the following industrial materials and activities:drums, barrels, tanks, and
similar containers that are tightly sealed,provided those containers are not deteriorated and do not leak.
"Sealed"means banded or otherwise secured and with locked or nonoperational taps or valves;
adequately maintained vehicles used in material handling;and final products, other than products that
would be mobilized in stormwater discharges(e.g.,rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.
In.addition, the exclusion from NPDES permitting is available on a facility-wide basis only—not for
individual outfalls. if any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form, you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five 5 ears.
For questions,please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator(address to which all certification correspondence will be mailed):
Name H:,ivb 11 L ►� Cld 1-�rA92Z- -_ +4 niLV-E(Z
Street Address `k 30 v C &. -%> .J e-
City P►4ZCH1Ac _ State C ZIP Cade
Telephone No. 'S'36 ` -b* -7-`ba c A� Fax: 1:bA 1 5a o
2) Location of facility producing discharge:
Facility Name 1Au 6 3 F_L-L 1 c—D
Facility Contact V%Avlq-
Street Address —A Z10 i 0 n .1
City 'Floc!-t�� State �-- Zip aka 3
County lZA-15 0-0�=FA
Telephone No. _ Fax: 3.3 4, LA ?)A
Page 1 of 5
SWU-NE-060607 Last revised 06/06/07

ti
NCGNEOOOO No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility(use street names,state road numbers, and
distance and direction from a roadway intersection).VQe- . IRA le_i q h — 5&e A-tf P
(A copy of a map with the facility dearly located on it should be Wctuded with the certification application.)
4) Is the facility located on Native American Lands?X Yes ❑ No
5) Is this a Federal facility? ❑ Yes Of No
6) Latitude 35"I I "'t�8' Longitude-8 1 0 Z (deg,min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin -
X' Existing Dale operation began I410 J Ci
8) Was this facility or site ever covered under an NPDES Stomrwater Permit? ❑ Yes No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code(SIC Code)that describes the primary industrial
activity at this facility
SIC Code: 3 3
10) Provide a brief description of the types of industrial activities and products produced at this facility:
u u s+,t l,"L -..i `.e *aL C�N i"yL�L S —,�- 4 c4L.
o �i.�-L�oIS PrpsC-1 {�f2.� d gr,� r6 1 �1� � \iK'e 9
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
,X No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
FarMure Checklists(9Z.- 14.)
12) Are any of the following materials or activities exposed to precipitation,now or in the foreseeable
future? (Please check either"Yes"or"No.") ff you answer"Yes"to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes I/No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or is stormwater inlets from spilMeaks ❑ Yes ! No
c. Materials or products from past industrial activity ❑ Yes No
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes IyNo
e. Materials or products during foadinglunloacling or transporting activities ❑ Yes CK No
f. Materials or products stored outdoors(except final products intended for outside ❑ Yes No
use[e-g., new cars]where exposure to stormvwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NE-060607 Last revised 06/0"7

NCGNEOOOO No Exposure Certification
g_ Materials contained in open,deteriorated or leaking storage drums,barrels,tanks, D Yes MNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑Yes V No
the discharger
i.Waste material(except waste in covered,non-leaking containers[e_g_, dumpstersD ❑Yes fO No
j.Application or disposal of process wastewater(unless otherwise permitted) ❑Yes dfNo
k.Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑Yes U(No
otherwise regulated(i.e.,under an air duality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑Yes 0 No
(Le.,not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs,as well as drums,barrels, tanks,and similar containers ❑Yes it No
stored outside,has the facility had any releases in the past three(3)years?
13) Above Ground Storage Tanks(ASTs): If you answer"No"to any of the following items,you are not
eligible for the no exposure exclusion.
a.Are exterior ASTs or- - - .. pits,or Yes ❑ No
piping free of rust,damaged or weathered coating,
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTO If so,is it free of any 4 Yes ❑ No
cracks, holes, or evidence of leaks,and are drain valves maintained locked shut?
14) Secondary Containment: tf you answer"No"to any of the following items,you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers Or Yes ❑ No
(including drums,barrels,etc.)with a capacity of more than 660-galons?
b. Is secondary containment provided for above ground storage containers stored Yes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gailons?
c.Are release valves on all secondary containment structures locked? J Yes ❑ No
Page 3 of 5
SWU-NE-060607 Last revised 061OW7

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑Yes O(No
b_is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste k Yes ❑ No
generated per month)of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑Yes iI(No
generated per month)of hazardous waste?
If you answered yes to questions b. or c.,please provide the lowing information:
Types)ofwaste: A,�1� �el�i�rsq *4 r Alc+ 1� 1, �4(�rS T"i�.1Qr�( S i�rfS a47�ylrr4.
How is material stored:
Where is material stored__A N S t u-e- a -w r:
How many disposal shipments per year.
Name of transport 1 disposal vendor CC 0 F(o
Vendor address:1'75o Pptte-sa.J S'. rccArsi,a -r e
16) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of`no
exposure'and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document(except as allowed under 40 CFR 122.26(g)(2)).
I understand that i am obligated to sLdmvt a no exposure certification form once every five(51 Vears to the North Carolina
Division of Water Quality and, if requested to the operator of the local municipad separate storm sewer system(MS4)into
which the facility discharges(where applicable). 1 understand that I must allow the North Carolina Division of Water
Quality,or MS4 operator where the discharge is into the local MS4,in perform inspections to confirm the condition of no
exposure and to make such inspection repots publicly available upon request
in the event that the site no longer qualifies for a No Exposure Exclusion,I understand that I must obtain coverage under
an NPDES permit prior to arty point source discharge of stormwater from the faality.Aftlionaliy, I certify under penalty
of law that tins document and all attachments were prepared under my direction or supervision in accordance with a
system designed to asswe that qualified personnel property gathered and evaluated the information submitted. Based
on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true,accurate and complete. I am aware
that there are significant penalties for subrnithng false bzforrnation,including the pessibihty of fine and imprisonment for
knowing violations,
t certify that I am familiar with the information contained in this application and that to the best of my knowledge and
belief such information is true,complete,and accurate.
Printed Name of Person Signing, tiZ t_-+p
Title: -- -�+sJi 2bN�?�n1T QorLr�:Ns}40 0- -
(Signature 4APP (Dale Signed)
Please mote: This applicado►r for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no eiqosure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in tyre future for compliance wilh the No Exposure Exclusion.
Page 4 of 5
SWU-NE4)6"7 last revised 06/06/07

ATTACHMENT II
Waste Flammable liquid — Paint, Naphtha
Hazardous Waste Solid — Lead
Hazardous waste Solid — Mercury
Waste Flammable liquid — Mineral Spirits
Petroleum Gases Uquified — Propane

•t
NCGNE0000 No Exposure Certification
North Carolina General Statute 143 216.6 B(i) provides that:
Any person who knowingly makes any talse staterrrerd,representation.or certification in any application,record,report,plan,or other
document filed or required to be maintained under this Article or a nee irrplernertirg this Article;or who knowingly makes a false
statement of a material fad in a rulemaldng prixmedi g or contested rase under thins Article;or who falsifies,tampers with,or knowingly
renders inaccurate any recordig or moratorinp device or method req{'red to be operated or maintained under ttvs Article or rules of the
[Environmental Management]Commission implementing this Article shalt be guilty of a Class 2 rrbsderneanor which may include a fine
not to exceed ten thousand dollars($10,000).
There is cumendy no fee for a No Exposure Exclusion.
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
_ Raleigh,.North.Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DWQ Region!Office for your area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone]
44,
Fayetteville Office ... [phone] I j'
Mooresville Office ... [phone] �
Raleigh Office ........ (919) 7914200
Washington Office _..(252) 41
946-6481
Wilmington Office .._ [phone] p-
Winston-Salem ,..... [phone] �[" •. r,
Central Office .........[phone] '• .�;�. �°'"
�'� srtgtnn
Page 5 of 5
S W U-N E-060607 Last revised 06/06/07

Re: [Fwd: Pallets?]
Subject: Re: [Fwd: Pallets?]
From: Ken Pickle <[e-mail]>
Date: Tue, 18 Nov 2008 08:44:34 -0500
To: Mike Mickey <[e-mail]>
CC: Bradley Bennett <[e-mail]>
Hey Mike,
Just spoke with Bradley on this question. To clarify:
a) Our historical posture has been that (new, unused) pallets stored outside (DO NOT
constitute exposure) . (All other) outside pallets are presumed to have the
potential for contamination via prior use, and (DO constitute exposure. ) -
b) We are not clear on whether the regions have always advised dischargers in
accordance with Central Office' s historical posture.
c) Of course, the question only pertains to the consideration of the No Exposure
Exclusion from permitting, i.e. if a facility is considering applying for No
Exposure, as in your case. I can't imagine circumstances where the question would
be relevant to any other consideration for an industrial discharger.
Ken
Mike Mickey wrote:
Hi Ken - Just checking back to make sure you got my question from last week.
Mike.
-------- Original Message --------
Subject: Pallets?
Date: Thu, 13 Nov 2008 14 :55:43 -0500
From: Mike Mickey <[e-mail]>
Organization: NC DENR - Winston-Salem Regional Office
To: Ken Pickle <[e-mail]>
Ken - I inspected an industry today in response to their request for a no
exposure exemption. Observations outside the facility did not reveal any major
problems. However, they did have a some pallets that were exposed to
stormwater. Is that a problem? I quizzed WSRO staff on how they handle pallets
in regards to NOE requests and received three different answers: 1) pallets are
okay, 2) pallets are not okay, and 3) only new.pallets are okay. Any guidance
you could provide to assist with this quandary would be appreciated. Thanks,
Mike.
Mike Mickey \
NC DENR Winston-Salem Regional Office � ���,`� \\--'-D�OQ
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Main Office: (336) 771--5000
Voice: (336) 771-4962 FAX: (336) 771-4630
Mike Mickey \
� 85Ww QWM,
I of 2 1 1/18/2008 9:06 AM

Comments for NGNE0510
Subject: Comments for NGNE0510
From: Mike Mickey <[e-mail]>
Date: Tue, 09 Dec 2008 13:00:56 -0500
To: Sarah Young <Sarah.Young a ncmaiI net>
Sarah - Hubbell ICD meets the conditions to qualify for the No Exposure Certification. Please issue.
Thanks. Mike.
Mike Mickey
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Main Office: (336) 771-5000
Voice: (336) 771-4962
FAX: (336) 771-4630
1 of 1 12/9/2008 1:01 PM

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1 of 1 10/21/2008 3:51 PM

_. she ✓S
FOR AGENCY USE ONLY
Date 7kA
Division of Water Quality/Surface Water Protection Year I Moenth I Day
V_LL
�C���R National Pollutant Discharge Elimination System Certificate of ovewe D
NiCIGiNIN
WC CNlO.JIY OEFMAT -TOF NO EXPOSURE CERTIFICATION for Exclusion
EMVFp—CT AMfl N.4tiiiAl ftC94URCG9 '
NCGNE0000 �
d
NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusion from O ate?Perm�t. ,
a i3
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility doe's'n e p
authorization for its stormwater discharges associated with industrial activity in the State. IVorthJ'
Carolina because it qualifies for a no exposure exclusion.A condition of no exposure at a� /
facility means all industrial materials and activities are protected by a storm resistant shelfe� e
exceptions)to prevent exposure to rain, snow,snowmelt, and/or runoff.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products,by-products, final products, or waste
products. Material handling activities include the storage, loading and unloading, transportation, or
conveyance of any raw material, intermediate product, Final product or waste producL A storm resistant
shelter is not required for the following industrial materials and activities:drums, barrels, tanks, and
similar containers that are tightly sealed,provided those containers are not deteriorated and do not leak.
"Sealed"means banded or otherwise secured and with lacked or non-operational taps or valves;
adequately maintained vehicles used in material handling;and final products,other than products that
would be mobilized in stormwater discharges(e.g., rock salt).
A No Exposure Certification must be provided for each facilify qualifying for the no exposure exclusion.
In addition, the exclusion from NPDES permitting is available on a facility-wide basis only--not for
individual outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion.By signing and submitting this No Exposure
Certification form,you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five 5 ears.
For questions,please contact the DWQ Regional Office for your area.(See page 5)
(Please print or type)
1) Mailing address of ownerloperator(address to which all certification correspondence will be mailed):
Name ►+Abbe 11 71 C- C> C/O `I4Pjt9-,..k
Street Address 30 k [ ,►e-
City A��H r�a�� State C ZIP Code 77-"1
Telephone No. '5,36 A-3 4-Z B a a Fax: 32,4� t 3 A -"L o -
2) Location of facility producing discharge:
Facility Name 1ALk a 3 E LL c-j>
Facility Contact
Street Address `43o t n eJ
City AR De L-r-- State t- ZIP Code 2- io 3
County 9Am ,>oL-
Telephone No. 31(o ikagy -Z oo Fax: 33 4. 4 -,q -Z�a
Page 1 of 5
SWU-NE-06M7 Last revised 06106107

NCGNE0000 No Exposure Certification
3) Physical location information:
Please provide a narratrve description of how to get to the facility(use street names,state road numbers, and
distance and direction from a roadway intersection)-V2o 7S C A-ffA,H,(�
(A copy of a map with the facility dearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands?)I Yes ❑ No
5) is this a Federal facility? Q Yes �V No
6) Latitude 5S O 1 1 " '�)a' Longitude-8 I Z (deg,min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed FacHity Date operation is to begin
f$' Existing Date operation began 004 / Ci
8) Was this facility or site ever covered under an NPDES Stonnwater Permit? Q Yes No
If yes,what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code(SIC Code)that describes the primary industrial
activity at this facility
SIC Code,
10) Provide a brief description of the types of industrial activities and products produced at this facil'
�pV�Cr 9
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
,(No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility_
Er sure Checklists(12. - 14.)
12) Are any of the following materials or activities exposed to precipitation,now or in the foreseeable
future? (Please check either"Yes"or"No.") If you answer"Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes )No
residuals from using,storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes 64 No
c. Materials or products from past industrial activity ❑ Yes M No
d- Material handling equipment(except adequately maintained vehicles) ❑ Yes Q(No
e. Materials or products during loadinglunfoading or transporting activities ❑ Yes X No
f. Materials or products stored outdoors(except final products intended for outside ❑ Yes A No
use(e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
swU-NE-060607 La6l reed 06106/07

NCGNEGD08 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums,barrels,tanks, ❑ Yes �(No
and similar containers
h_ Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes a No
the discharger
i.Waste material(except waste in covered,non-leaking containers[e_g_, dumpsters)) ❑ Yes 66 No
j.Application or disposal of process wastewater(unless otherwise permitted) © Yes No
k_ Particulate matter or visible deposits of residuals from roof stacks andlor vents not ❑ Yes U'(No
otherwise regulated(i.e.,under an air quality control permit) and evident in the
stormwater outflow
1. Empty containers that previously contained materials that are not properly stored ❑ Yes ill No
(i_e_, not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs,as well as drums,barrels, tanks,and similar containers ❑ Yes No
stored outside,has the facility had any releases in the past three(3) years?
13) Above Ground Storage Tanks(ASTs): If you answer"No"to any of the following items,you are not
eligible for the no exposure exclusion.
a.Are exterior ASTs or piping free of riist,damaged or weathered coating,pits,or Yes © No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any Yes ❑ No
cracks, holes,or evidence of leaks,and are drain valves maintained locked shut?
14) Secondary Containment: If you answer"No"to any of the following items, you are not eligible for the
no exposure exclusion.
a.Is secondary containment provided for single above ground storage containers OrYes ❑ No
(including drums, barrels,etc.)with a opacity of more than 660-gallons?
b. Is secondary containment provided for alcove ground storage containers stored Yes ❑ No
in dose proximity to each other with a combined capacity of more than 1,320-
gallons?
c.'Are release valves on aH secondary containment structures locked? fkf Yes ❑ No
Page 3 of 5
SWU-NE4)60607 Last revised 06/06/07

NCGNEOOOQ No Exposure Certification
15) Hazardous Waste:
a_ Is this facility a Hazardous Waste Treatment, Storage,or Disposal Facility?. ❑Yes CY No
b_ Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste [V Yes 0 No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes I No
generated per month)of hazardous waste?
If you answered yes to questions b.or c.,please provide the following information:
Type(S) Of Waste: e.l t C e t 4l e c� sa'l�c c� �� 1, �+11rS M�J4��t c� i r� t-,
^ �5 r e a Ifr L
How is material stored: CA 0ere-
4
Where is material stored_ [N S n uy_ a d e-A i Cw-4-e cQ S}o r e SH 2 _ _w i Co 14-,►n
How many disposal shipments per year: I o-,r
Name of transport/disposal vendor: t`c o F[o
Vendor address: �-7 s e-c Aix Le rJC , :;t I k(d�-
16) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of'no
exposure'and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwrater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document(except as allowed under 40 CFR 122.26(g)(2)).
I unclers#and that I am obligated to submit a no ex slue certification form once eve a _5 ears to the North Carolina
Division of Wager Quality and, if requested,to the operator of the local municipal separate storm sewer system(MS4)into
which the facility discharges(where applicable). 1 understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4,to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request
In the event that the site no longer qualifies for a No Exposure Exclusion,I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility.Additionally, I certify under penalty
of law that OVS document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel property gathered and evaluated the information submitted. Based
on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibitity of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and
belief such information is true,complete, and accurate.
Printed Name of Person Signing: ►2-14 ALA PA
Title: J Il I r2 b/V /L
o`t
(Signature (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at arry time in the future for comptiance with the No Exposure Exclusion.
Page 4of5
SWU-NE-060607 Last revised W06/07

Driving Directions from Ra Page I of 2
Sorry! When printing di int the
.�' entire map, try clicking ATTACHMENT I
► -
Raleigh, NC 27699, U5 4301 Cheyenne Dr
Archdale, NC 27263-3246, US
Total Est. Time: Total Est. Distance:
1 hour, 44 minutes 101.27 miles
Maneuvers Distance
" 1: Start out going SOUTH on SOLHEIM LN toward CUPP CT. 0.1 miles
O2: Turn LEFT onto MEDIATE DR. <0.1 miles
O3: Turn RIGHT onto SUGARLOAF WAY. <0.1 miles
O4: Turn LEFT onto SEASTONE ST. <0.1 miles
O5: Turn LEFT onto OLD STAGE RD. 3.5 miles
6: Turn RIGHT onto FAYE77EVILLE RD/ US-401 N. Continue to follow US- 3.0 miles
401 N.
7: Merge onto I-40.W.via the.ramp.on the LEFT.toward CARY/ DURHAM.. 71.1.miles-.- .
s
$: Take I-85 S toward CHARLOTTE. 21.4 miles
9: Take the US-311 exit- EXIT 111- toward ARCHDALE / HIGH POINT- 0.2 miles
J DOWNTOWN.
O 10: Turn LEFT onto US-311 / N MAIN ST/ S MAIN ST. Continue to follow 0.5 miles
US-311 / N MAIN ST.
/\ li: Turn RIGHT onto COMANCHE DR. 0.4 miles
O12. COMANCHE DR becomes CHEYENNE DR. 0.6 miles
13: End at 4301 Cheyenne Dr
Archdale, NC 27263-3246, US
Total Est. Time: 1 hour, 44 minutes Total Est. Distance: 101.27 miles
littn://www.maoouest.cam/directions/main.ada?P-cr=1&do=nw&rmm=l&un—m&cl=EN&oo=IADnnk24o 7/9-4/2007

Driving Directions From Raleigh, NC to 4301 Cheyenne Dr, Archdale, NC Page 2 of
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expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use.

ATTACHMENT II
Waste Flammable liquid — Paint, Naphtha
Hazardous Waste Solid — Lead
Hazardous waste Solid — Mercury
Waste Flammable liquid — Mineral Spirits
Petroleum Gases Liquified — Propane

NCGNEOOOO No Exposure Certification
North Carolina General Statute 143 215.6 B(i)provides that:
Any person who knowingly makes any False statement,representation,or certification in any application,record.report.plan,or other
document filed or required to be maintained ur>aer this Article or a nye jn;*yn-nfing this Article;or who knowingly makes a false
statement of a material tad in a ruiema"procoedkV or cordested case under ttis Article;or who falsifies,tampers with,or knowingly
renders inaccurate arty recording or rnonitorkV device or method requirW to be operated or makilairred under this Article or rules of the
[Environmental Management)Commission irnpiemerti V this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand doLws($10,000).
There is currently no fee for a No Exposure Exclusion.
Final Checklist
This application should include the following items:
© This completed application and all supporting documentation.
El A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center _.....
Raleigh,.North.Carolina 27699-1617_
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DWO Regional Office for your area.
DWQ_Regional Office Contact Information:
—17
f Wrw�kun:Soirep - - �_
Asheville Office ...... [phone] $
Fayetteville Office ... [phone]
� N
Mooresville Office ... [phone]
Raleigh Office ........ [phone] w a _ ' , - ` ,
Washington Office ...(252) 946-648171,
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone] ,
r�ldri
Page 5of5
SWU-NE-060607 Last revised 06/06107